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Interoperability and Accountability

Recently ONC released its ‘Interoperability Roadmap’ as a framework for the transmission of clinical electronic health records consistent with the goals of the HITECH Act. The ‘Roadmap’ has been criticized as actually delaying Interoperability because of an emphasis on theoretical concepts rather than realistic...Read more...

Provider Databases - 2014 in Review

2014 was marked by two fundamental trends impacting Provider Databases: (1) a substantial increase in the number and scope of ‘available’ Provider Data ‘sources’ and (2) an increase in the cost of inaccurate Provider information. Simultaneous with the growth of EHRs has been an increase in the amount of Provider information available... Read more...

‘New’ Hospital EMRs –Implications for Provider Databases

A recent report by the Klas Research organization revealed that the two major hospital EMR vendors, Epic and Cerner, took a combined 60% market share of all new hospital EMR systems purchases in 2013. And Epic has passed Meditech in overall number of hospital EMR systems installed, topping over 1,000 hospitals. Read more...

Affordable Care Act (ACA), Nurse Practitioners, and Provider Databases

The Affordable Care Act (ACA) has had an uneven beginning but appears to be gaining traction in expanding health insurance to uninsured Americans. The ACA will have an impact on Provider Databases as a result of increases in referrals and changes in referral patterns with new insurance networks.

One other ACA impact on Provider Databases results from the restrained growth in new physicians in the U.S. coupled with the increased retirement of the existing ‘boomer’ generation of physicians.

The demand/supply imbalance coupled with the desire to ameliorate the rise in healthcare costs will undoubtedly lead to greater use of ‘non physicians’ performing primary care services... Read more...

Provider Databases: A National Problem

Much of the improvement in health care and efficiency rests on the foundation of accurate and up-to-date Provider information for efficient and error free billing, medical records and transcription…and even more importantly on long term patient ‘Continuity of Care’.

The emphasis on accurate Provider information has exposed weaknesses: a 2013 OIG report* found that 48% of Medicaid’s NPPES provider databases contain errors; California was forced to remove its Physician Directories from its state run Health Information Exchange (HIE) because of inaccuracies; and recently the ONC sponsored HIE Provider Directory Workgroup disbanded without any serious, feasible recommendations for implementation. Read more...

OBAMACARE and Legacy Provider Databases

The implementation of Obamacare and the resulting increase in newly insured Americas will have important implications for legacy referring provider databases in healthcare organizations as they attempt to provide coordination of care.

This is a result of two factors: First, the newly insured population will, in most cases, have received some form of healthcare… in the past and relied on a physician(s), nurse practitioner(s) or physician assistant(s) for health services. It is unlikely that these prior ‘uninsureds’ will have the same healthcare providers in the future. As a result, in coordinating care, providers will need to identify entirely new sets of providers and types of providers. Second... Read more...

New Guidance and Penalties for Healthcare Transactions with ‘Excludeds’

In May, 2013 the Office of Inspector General (OIG) of Health and Human Services (HHS) issued new guidance on the penalties associated with the payment of claims made to 'Excluded individuals or entities' for any Federal Health program (primarily Medicare and Medicaid). The authority to impose civil fines and deny payment for claims resides in various Federal statutes including most recently the Affordable Care Act of 2010. An Excluded person or entity is defined as one who has engaged in fraud or abuse related to Federal Health programs and the penalties may include a $10,000 fine for each claimed item or service and may also be subject to an assessment of up to 3X the amount claimed.

Guidance on what constitutes liability, falls not only on the Excluded person or entity BUT ALSO TO A NON-EXCLUDED PERSON, PROVIDED the NON-EXCLUDED PERSON KNEW or 'SHOULD HAVE KNOWN' they were dealing with an 'Excluded' person.

As examples:

Inaccuracies in Medicare and Medicaid Provider Data Highlighted

A May 2013 Office of Inspector General for the Department of Health and Human Services report* analyzed the Provider data files of Medicare and found a very high error rate.

To quote portions of the Executive Summary:

“Medicare provider data in NPPES (National Plan and Provider Enumeration System) and PECOS (Provider Enrollment, Chain and Ownership System) were often inaccurate. In NPPES, provider data were inaccurate in 48% of records…. in PECOS, provider data were inaccurate in 58% of records…Addresses, which are essential for contacting providers and identifying trends in fraud, waste, and abuse, were the source of most inaccuracies and inconsistencies. Finally, CMA did not verify most provider information in NPPES and PECOS….” Read more...

Electronic Medical Record Successful Usage - Fact or Figment?

Recently Health and Human Services announced that it had exceeded its target of Electronic Medical Record (EMR) implementation by paying more that 50% of ‘Eligible Professionals’ almost $6 billion in incentive payments (with more to come)based on their ‘Meaningful Use’ of EMR systems. All of this effort is an outgrowth of the requirements in the American Recovery and Reinvestment Act of 2009 (ARRA), the so-called Stimulus Bill.

Indeed this can be seen as a milestone in the overarching effort to migrate the healthcare industry to EMRs but more importantly introduce interoperability between healthcare parties for EMR transmissions via Health Information Exchanges (HIEs).

Moreover the industry, which is the beneficiary of the incentive payments, has by and large endorsed the program.

But, is this an unqualified success? There do appear to be several considerations that might temper this ‘success’. Read more...

Domestic and International Medical School Education for Physicians in Massachusetts – A Perspective

Source: FolioMed Provider Data Management Statistical Data

One of the issues facing the new changes in healthcare is the ability of Physicians to respond to the increase in uninsured patients who would be eligible for insured and routine medical services. By one count if there are roughly 300,000+ actively practicing Primary Care Physicians (PCP)* in the country and 30 million newly insured, that implies a net gain of 100 patients per PCP. Using an average multiple of 4 visits a year, there could be up to 400 additional patient visits per PCP. And, assuming a 20 patient day, approximately one additional month of patient care per year per PCP.

Numbers can be disputed but whatever the result there will no doubt be an increase in the demand for PCP services. One of the solutions to solving this capacity ‘problem’ would be to allow less than fully licensed Physicians, such as Physician Assistants and Nurse Practitioners, to screen and treat patients and assume some of the traditional functions normally reserved for Physicians. Another solution would be to increase the available ‘supply’ of Physicians by either increasing the number of US medical schools (a very long term approach) or encouraging the entry of more Physicians educated in foreign medical schools. Read more...

ONC for Health Information Technology “Direct White Pages” Pilot

A recent Power Point Presentation was made by the ONC for Health Information Technology on a
Direct White Pages” Pilot

The pilot proposes to address the issue of developing a Provider Directory as one means of implementing messages between users in a ‘Direct’ environment, that is, in an electronic environment.

Since the concept of a Provider Directory in order to implement messaging in an EHR world has been debated for years without (except for a few rare cases) any notable successes, the ONC wants to pilot with the experience of states to develop, in their words, a ‘Direct White Pages’ of Providers.

In order to do this they propose to use as a data collection vehicle state-level Medicaid attestation data, specifically the ‘Direct’ addresses of providers attesting to the State’s EHR incentive program for Medicaid.

Is this a good idea?


EMR vs. EHR and why Provider Data as a Service matters - Market Launch Group, August 2, 2012

The EMR vs. EHR description below may seem like a semantic argument and is not agreed to by all vendors. However, we need to remember the massive federal funds being driven into Healthcare IT are supposed to solve what can be viewed as THE major health care challenge….a communication problem. The work being done by FolioMed around Provider Data as a Service can be viewed as the missing piece (aka the telephone/address/specialty/affiliation/ contact directory). Regardless of it being called an EMR or an EHR if the Provider data is not highly accurate then it fails to solve the communication problem. Provider Data as a Service effectively solve the communication problem

What’s the Difference?


FolioMed announced today that it has begun a new service that consists of Monthly Verification of New Physician Providers that are included in the updated files released by the NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM .

The new service will be part of FolioMed’s ‘PROVIDER DATA AS A SERVICE’ for hospital and other healthcare institutions that rely on FolioMed for verified and accurate provider databases. The new service will be made available immediately to current ‘Data Licensing’ and ‘Synchronized Reference Database’ customers, but also can be licensed as a stand-alone module, according to Paul Rooker, President of FolioMed.

“With the development of Health Information Exchanges and the increased requirement for accurate and validated Provider information in communicating electronic records, this enhancement to FolioMed’s database software tools and interactive Database services responds to a widespread industry need”, he stated. “That need results in part from the difficulty in sorting through the volume and complexity of the many conflicting databases of new Providers. FolioMed’s software tools are able to integrate disparate databases into meaningful information and then apply processes to timely validate information. This is especially critical in identifying and monitoring the rapidly changing practice patterns of new Providers entering the market.”


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